A Facebook friend posted a link to a news story about how insurance companies still say they will fight to deny coverage of preexisting conditions. I replied that I am sickened (no pun intended) by the people throwing bricks through congressional office windows, spitting on politicians, firing bullets into a congressional office, cutting a gas line at a politician’s family member’s house and calling in death threats, all in the name of defending this horrid status quo.

She asked me in reply “What do you think of all this health care stuff?”

I don’t know how much I have written about it recently, even though I have been following the debate avidly. I got turned off one step at a time with each compromise that was made, when each compromise didn’t earn one single Republican vote. What could have been a progressive reform pretty much got turned into a pretty close copy of the Republican’s answer to the Clinton era Democratic reform proposal. In fact, it uses a lot of ideas from the Republican platform in the 2008 election. We scuttled the public option, contraception coverage, put in extra barriers to abortion, cut the minimum of premiums taken in that had to go to actual medical care, removed end of life counseling, put in mandates, etc. etc. Although I think we have a gutted shell of a reform plan, it is still better than the status quo.

Here is my reply:

I am a big fan of the book “The Healing of America” by T.R. Reid. He looks at health care delivery and payment in several “civilized” countries, including countries like Switzerland that made their transition when we failed during the Clinton era.

It is grossly apparent to anyone who looks, apolitically, at health outcomes, disparities and access that the United States has one of if not the worst health care systems in the industrialized world.

I think we could easily switch over to a single payment system by simply expanding Medicare to pay for all, and then use the best elements from all of the health care systems that already work much better than ours. It’s not like there isn’t ample good examples around. Japan’s cost control and ample access to excellent practitioners and treatments (more visits to physicians per year than the US and best in all outcomes, with a fraction of our cost, and universal coverage), Canada’s self referral system, France’s electronic records card and billing (which would save billions in overhead in offices and hospitals) – for the doctors and business owners, not just the government and patients!), England’s subsidized medical education (in fact, most countries have this), and even Germany’s use of existing private insurance companies to organize the care.

What I don’t like is the knee jerk, angry reaction we have to this kind of reform in our country. In Canada, in Japan, in the UK, this isn’t a left/ right issue. It’s a matter of human rights, and it’s hard to find a politician of any stripe who wants to switch to the US system. In fact, it’s a common insult in the UK in parliament to say that another politician would rather have the US health care chaos, and it’s used by both sides.

As a future practitioner, I would hate to have to turn down a pregnant patient like I was turned down as having a “pre-existing condition” when I was pregnant. Fundamentally, I can’t see why anyone in the health care industry would support the status quo.

5 responses to “Reply turned post, health care reform style”

I think, however, that there are two levels to the disagreements over health care. On the one hand, there are disagreements over what the appropriate policy approach is. This, while it may be driven by lobbying and special interests, is at least a normal political divide, and is the kind of disagreement that many a back-room deal has smoothed over without major trouble on other sticky issues. Now, I personally do not believe that a privatized health care system as we currently have is a valid policy option in a modern republic such as ours, but that’s my political opinion, and people have a right to disagree with me. If this were the central problem, a political disagreement, then the majority would rule, we would get a policy change, and things would move on. The problem is, that’s not the real problem.

On the other hand, there is a level of outrage completely out of proportion to and incoherent with real concerns about health care. In fact, that outrage has NOTHING to do with health care at all. Rather, it is about resistance to inexorable social progress, and I believe that it would have looked like this regardless of what the instigating base issue was (health care, immigration, environment, you name it). It would be too easy to say that this was racism, but I do believe that racism is playing a part. It is also a deeply pathological fear of change that besets certain demographic groups in our country and can be easily fanned by politicians who stand to gain from it in the short run. This is the outrage that manifests itself in violence and irrational belief in outright lies. There is no political response to be made, because none would suffice. The only response is to continue to move forward, allowing these people to fade off into the fringes again as we reclaim the center.

I think both you and Maureen have certainly put your finger on some of it. I have to say in all I’ve settled on the “it’s better than nothing at all” approach.

It seems to me that every time a big reform like this has happened we end up with “better than nothing” and thought that future legislators would make it better…only to find out that the “better than nothing” is all we have. I find myself hoping that won’t be the case with health insurance reform (Because that’s what this was, wasn’t it? If it were really health *care* reform a lot more would have to be done).

As for the rest of the world? I think Sarkozy put it best:
“The very fact that there should have been such a violent debate simply on the fact that the poorest of Americans should not be left out in the streets without a cent to look after them … is something astonishing to us.”

It’s times like this when I completely understand why the rest of the world thinks the way they do about us. I feel a little squeamish myself knowing that this is how America is being portrayed: as selfish, moronic, stagnant, greedy assholes.

We lived overseas for a while in Spain. I gave birth to all three of my babies there. One aspect of a single payer model that we saw while living there was that a private health insurance system still exists. But since they are competing with “free” – as in already covered by taxes and no out of pocket expenses for the state plan – the private insurance was very affordable. We paid less for a family of five there than a single person does here. (Our employer opted to provide us with the private health insurance as well.) My caregivers took my card and we never paid a cent beyond our premiums for any prenatal care, the birth or the hospital stay. I recognize that there will never be a perfect system in place in any country, but I think a single payer system could be a huge improvement on so many level to the mess we currently have.